IVY PARK AT SIMI VALLEY

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and record review, the Licensee did not comply with the section cited above as S1 and S2 were disassociated on 01/01/2026 but continued to work at the facility, which poses an immediate safety risk to residents in care.

Official plan of correction

POC Due Date: 04/10/2026 Plan of Correction Staff were re-associated to the facility during the inspection. POC has been met.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require, including: Any incident which threatens the welfare, safety or health of any resident… This requirement has not been met as evidenced by: Based on record review, the licensee did not comply with the section cited above as the facility did not submit LIC 624 within seven (7) days of occurrence for R1’s hospital visit, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to send LIC 624 for R1’s hospital visit to CCL no later than POC due date.

Deadline recorded: Jan 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1-3)

Regulation authority

CCR

What the official deficiency says

Residents shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (3) To be free from abuse or other actions of a punitive nature. This requirement has not been met as evidenced by: Based on the investigation, the Licensee did not comply with the section cited above as R2 was observed speaking inappropriately to R1 on several occasions, which poses a potential health, safety, and/or personal rights risks to persons in care.

Official plan of correction

The Licensee has agreed to have staff training on residents’ personal rights and submit proof (training materials along with staff signatures) to CCL no later than POC due date.

Deadline recorded: Jan 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above, as the facility staff could not provide confirmation that R2’s pain patch was replaced as prescribed, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to review section cited and provide a statement of understanding along with a plan of how they will ensure future compliance then send to LPA via email by COB 05/20/2025.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(1) Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on information obtained and reviewed, including interviews, the Licensee did not comply with the section cited above as facility staff were observed yelling in the presence of residents, which poses a potential personal rights risk to residents in care.

Official plan of correction

The Licensee has agreed to have a staff training on resident’s personal rights and submit proof to CCL no later than POC due date. POC has been met.

Deadline recorded: May 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

1569.312(a) Basic services shall at a minimum include: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as staff did not check on R1 in a timely manner resulting in R1 sustaining multiple injuries, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to submit a plan on how they will ensure appropriate care and supervision to meet the needs of residents and submit to CCL on or before POC due date.

Deadline recorded: Sep 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) Personal Rights of Residents in All facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above as facility staff did not ensure that resident’s call pendant for assistance was functioning properly, which posed a potential risk to residents in care.

Official plan of correction

Licensee agreed to have an in-service with staff regarding answering call pendants / pull chords in a timely manner and submit proof to CCL on or before POC due date.

Deadline recorded: Sep 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 (a)(4) Incidental Medical and Dental Care. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above as medications are not being properly documented on the CSMDR once received, which posed an immediate health and safety concern to persons in care.

Official plan of correction

The Licensee will review Regulation and have staff training on how to properly document medication on the CSMDR and submit proof to CCL on or before POC due date.

Deadline recorded: Sep 30, 2024. A deadline is not proof that correction was completed.